MRI在新生儿点状脑白质病灶分类研究中的价值

The Value of MRI in the Classification of Punctate White Matter Lesions in Newborns

目的:探讨MRI在新生儿点状脑白质病灶(PWML)分类研究中的价值,以提高对本病的认识。方法:回顾2020年1月至2021年12月共491例新生儿资料,共66例发现点状脑白质病灶,其中男38例,女28例,年龄6~31 d,平均年龄16.1 d,中位年龄14 d。将MRI检查脑白质中以T1W高信号和/或T2W低信号的小片区域定义为PWML。分析这66例临床特点和MRI表现,并使用磁敏感加权成像(SWI)序列对病灶性质进行分类,并对病灶数量、与侧脑室壁距离、在横断面上区域分布等进行分析。结果:(1)病灶数量与分类:66例病例共有病灶514个。其中119个(23.2%)病灶在SWI序列表现为低信号(SWI+),提示含铁血黄素沉着;395个(76.8%)病灶在SWI序列表现为等或高信号(SWI-),提示早期胶质增生。(2)与侧脑室壁距离:所有SWI+的病灶,与侧脑室壁的距离为(3.23±1.60)mm;所有SWI-的病灶,与侧脑室壁的距离为(5.90±2.52)mm。(3)横断面上分布:SWI+病灶分布于大脑前区、中区、后区者分别为16个(13.4%)、28个(23.5%)、75个(63.1%);SWI-分布于大脑前区、中区、后区者分别为58个(14.7%)、143个(36.2%)、194个(49.1%)。统计学分析显示,与SWI-病灶比较,SWI+病灶数量更少,与侧脑室壁距离更近,两者均以大脑中、后区分布为主。结论:诊疗水平的不断提高使得新生儿特别是早产儿的生存率不断提高,但新生儿相关脑白质损伤的发生率有所增加;MRI各项新技术的发展,使得本病研究不断得以深入,并可以成为新生儿神经发育评估的一项重要指标。

Purpose: To discuss the value of MRI in the classifications of punctate white matter lesion(PWML) in neonates in order to improve the knowledge of this disease. Methods: The data of 491 newborns from January 2020 to December 2021 were reviewed, PWMLs were found in 66 cases, which included 38 males and 28 females,aged from 6 days to 31 days, with an average age of 16.1 days and a median age of 14 days. PWMLs were defined as small areas of T1W high intensity signal and/or T2W low intensity signal in white matter examined by MRI. The clinical characteristics and MRI findings of PWMLs were analyzed. The nature of the lesions was classified by susceptibility weighted imaging(SWI). The number of lesions, the distances from the lateral ventricular wall, the distribution on the axial plane were analyzed. Results:(1) Number and classification of lesions: there were 514 lesions in 66 cases. Among them, 119(23.2%) lesions were low signal(SWI+) in SWI sequence, suggesting hemosiderosis;395(76.8%) lesions showed iso or high signal(SWI-) in SWI sequence, suggesting early gliosis.(2) Distance from the lesions to the lateral ventricular wall: the distances from SWI+ lesions to the lateral ventricular wall were(3.23±1.60) mm;the distances between the lesions of SWI-and the lateral ventricular wall were(5.90±2.52) mm.(3) Distribution on the axial plane: 16(13.4%), 28(23.5%) and 75(63.1%) SWI+ lesions were distributed in the anterior, middle and posterior regions of the brain, respectively;58(14.7%), 143(36.2%) and 194(49.1%) of SWI-lesions were distributed in the anterior, middle and posterior regions of the brain, respectively. Statistical analysis showed that compared with PWMLs of SWI-, the number of SWI+ was relatively less and closer to the lateral ventricular wall. SWI+ and SWI-lesions were mainly distributed in the middle and posterior regions of the brain.Conclusion: With the continuous improvement of diagnosis and treatment level, the survival rate of newborns, especially premature infants, has been continuously improved, but the incidence of neonatal related white matter injury has increased. With the development of various new techniques of MRI, the research of this disease has been deepened and it can become an important index for the evaluation of neonatal neurodevelopment.